GH deficiency in cancer survivors in the transition age: diagnosis and therapy

Abstract

Background

Survival rates among childhood cancer survivors (CCSs) have significantly risen in the last 40 years due to substantial improvements in treatment protocols. However, this improvement has brought with it serious late effects that frequently involve the endocrine system. Of the endocrine disorders, GH deficiency (GHD) is the most common among CCSs as a consequence of a history of cancers, surgery, and/or radiotherapy involving the hypothalamo-pituitary region.

Methods

A comprehensive search of English language articles regardless of age was conducted in the MEDLINE database between December 2018 and October 2019. We selected all studies on GH therapy in CCSs during the transition age regarding the most challenging topics: when to retest; which diagnostic tests and cut-offs to use; when to start GH replacement therapy (GHRT); what GH dose to use; safety; quality of life, compliance and adherence to GHRT; interactions between GH and other hormonal replacement treatments.

Results

In the present review, we provide an overview of the current clinical management of challenges in GHD in cancer survivors in the transition age.

Conclusions

Endocrine dysfunction among CCSs has a high prevalence in the transition age and increase with time. Many endocrine disorders, including GHD, are often not diagnosed or under-diagnosed, probably due to the lack of specialized centers for the long-term follow-up. Therefore, it is crucial that transition specialized clinics should be increased in terms of number and specific skills in order to manage endocrine disorders in adolescence, a delicate and complex period of life. A multidisciplinary approach, also including psychological counseling, is essential in the follow-up and management of these patients in order to minimize their disabilities and maximize their quality of life.

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Fig. 1
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Abbreviations

GHD:

Growth hormone deficiency

QOL:

Quality of life

CNS:

Central nervous system

AGHDA:

Assessment of GH deficiency in adults

PGWB:

Psychological general well-being schedule

ITT:

Insulin tolerance test

SAS-SR:

Social Adjustment Scale Self Report Questionnaire

MPHD:

Multiple pituitary hormone deficiency

CCSs:

Childhood cancer survivors

SNs:

Second neoplasms

THs:

Thyroid hormones

GHRT:

Growth hormone replacement therapy

BMI:

Body mass index

FH:

Final height

TBI:

Total body irradiation

11β-HSD1:

11β-Hydroxysteroid dehydrogenase type 1

11β-HSD2:

11β-Hydroxysteroid dehydrogenase type 2

SDS:

Standard deviation score

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Acknowledgements

This study has been proposed and scientifically supported by the TALENT Study Group, Sapienza University of Rome, Italy.

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Correspondence to Emilia Sbardella.

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Emilia Sbardella, Marco Crocco, Tiziana Feola, Fortuna Papa, Giulia Puliani, Daniele Gianfrilli, Andrea M. Isidori and Ashley B. Grossman have no conflicts of interest.

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Sbardella, E., Crocco, M., Feola, T. et al. GH deficiency in cancer survivors in the transition age: diagnosis and therapy. Pituitary 23, 432–456 (2020). https://doi.org/10.1007/s11102-020-01052-0

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Keywords

  • Growth hormone
  • Transition
  • Adolescence
  • Cancer
  • Survivor